Clinical outcomes of temporary mechanical circulatory support as a direct bridge to heart transplantation: a nationwide Spanish registry
Barge-Caballero E (1), Almenar-Bonet L (2), Gonzalez-Vilchez F (3), Lambert-Rodríguez JL (4), González-Costello J (5), Segovia-Cubero J (6), Castel-Lavilla MA (7), Delgado-Jiménez J (8), Garrido-Bravo IP (9), Rangel-Sousa D (10), Martínez-Sellés M (11), De la Fuente-Galan L (12), Rábago-Juan-Aracil G (13), Sanz-Julve M (14), Hervás-Sotomayor D (15), Mirabet-Pérez S (16), Muñiz J (17), Crespo-Leiro MG (1).
(1) Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
(2) Hospital Universitario y Politécnico La Fe, Valencia, Spain.
(3) Hospital Universitario Marqués de Valdecilla, Santander, Spain.
(4) Hospital Universitario Central de Asturias, Oviedo, Spain.
(5) Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain.
(6) Hospital Universitario Puerta de Hierro, Madrid, Spain.
(7) Hospital Clinic i Provincial, Barcelona, Spain.
(8) Hospital Universitario Doce de Octubre, Madrid, Spain.
(9) Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
(10) Hospital Universitario Virgen del Rocio, Sevilla, Spain.
(11) Hospital Universitario Gregorio Marañon, Universidad Complutense, Universidad Europea, Madrid, Spain.
(12) Hospital Clínico Universitario, Valladolid, Spain.
(13) Clínica Universidad de Navarra, Pamplona, Spain.
(14) Hospital Universitario Miguel Servet, Zaragoza, Spain.
(15) Hospital Universitario Reina Sofia, Córdoba, Spain.
(16) Hospital Santa Creu i Sant Pau, Barcelona, Spain.
(17) Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña (UDC), A Coruña, Spain.
In Spain, listing for high-urgent heart transplantation is allowed for critically ill candidates not weanable from temporary mechanical circulatory support (T-MCS). We sought to analyse the clinical outcomes of this strategy.
METHODS AND RESULTS:
We conducted a case-by-case, retrospective review of clinical records of 291 adult patients listed for high-urgent heart transplantation under temporary devices from 2010 to 2015 in 16 Spanish institutions. Survival after listing and adverse clinical events were studied. At the time of listing, 169 (58%) patients were supported on veno-arterial extracorporeal membrane oxygenation (VA-ECMO), 70 (24%) on temporary left ventricular assist devices (T-LVAD) and 52 (18%) on temporary biventricular assist devices (T-BiVAD).
Seven patients transitioned from VA-ECMO to temporary ventricular assist devices while on the waiting list. Mean time on T-MCS was 13.1 ± 12.6 days. Mean time from listing to transplantation was 7.6 ± 8.5 days. Overall, 230 (79%) patients were transplanted and 54 (18.6%) died during MCS. In-hospital postoperative mortality after transplantation was 33.3%, 11.9% and 26.2% for patients bridged on VA-ECMO, T-LVAD and T-BiVAD, respectively (P = 0.008).
Overall survival from listing to hospital discharge was 54.4%, 78.6% and 55.8%, respectively (P = 0.002). T-LVAD support was independently associated with a lower risk of death over the first year after listing (hazard ratio 0.52, 95% confidence interval 0.30-0.92). Patients treated with VA-ECMO showed the highest incidence rate of adverse clinical events associated with T-MCS.
Temporary devices may be used to bridge critically ill candidates directly to heart transplantation in a setting of short waiting list times, as is the case of Spain. In our series, bridging with T-LVAD was associated with more favourable outcomes than bridging with T-BiVAD or VA-ECMO.
CITATION Eur J Heart Fail. 2018 Jan;20(1):178-186. doi: 10.1002/ejhf.956